Management at a distance is increasingly employed to organize hospital resources, of which professionally skilled staff is the key component. Mergers often imply distant management. The study examines the internal management aspects for two hospitals in two consecutive mergers, 5 years apart. We focus on how geographical and cognitive distances are experienced by middle managers and their followers. We find that the concept of distance plays significant and different roles in managing units in an organization with distant top management teams. Our findings indicate that hospital professionals' positive perception of their relationship with top managers, as measured by cognitive distance, can outweigh the possible negative effects of large geographical distances between hospital units and top management teams. Our study also indicates that information systems and communication mechanisms may mitigate the possible perceived negative effects of distance. Our findings imply that politicians, policymakers, and National Health Service' management should be aware of the effects of distances in implementing new collaborative management arrangements. We recognize that our study is limited in context, time, and scale. We welcome further research on comparative analyses of the complex interplay between physical and cognitive distances in other hospitals and also other types of organizations.